Long-term central venous catheter infection in HIV-infected and cancer patients: a multicenter cohort study.

OBJECTIVES

To evaluate and compare the risk of long-term central venous catheter (CVC) infection in human immunodeficiency virus (HIV)-infected and cancer patients.

DESIGN

Prospective multicenter cohort study based on active surveillance of long-term CVC manipulations and patient outcome over a 6-month period.

SETTING

Services of infectious diseases and oncology of 12 university hospitals in Paris, France.

PARTICIPANTS

In 1995, all HIV and cancer patients with solid malignancy were included at the time of long-term CVC implantation.

RESULTS

Overall, 31.6% of long-term CVC infections were identified in 32% of 201 HIV and 5% of 255 cancer patients. Most were associated with bacteremia, most commonly coagulase-negative staphylococci. The long-term CVC time-related infection risk was greater in HIV than in cancer patients (3.78 vs 0.39 infections per 1,000 long-term CVC days; P<.001). The independent risk factors of long-term CVC infection were as follows: in HIV patients, frequency of long-term CVC handling and neutropenia; in cancer patients, poor Karnofsky performance status; in both HIV and cancer patients, recent history of bacterial infection. The risk of long-term CVC infection was similar for tunneled catheters and venous access ports in each population.

CONCLUSIONS

Prevention of long-term CVC infection should focus first on better sterile precautions while handling long-term CVC, especially in HIV patients who have frequent and daily use of the long-term CVC.